EUS-guided choledochoduodenostomy as a rescue after failed ERCP and percutaneous transhepatic biliary drainage in the management of postoperative benign biliary stricture

Post written by Sundeep Lakhtakia, MD, MNAMS, DM, FASGE, from the Department of Medical Gastroenterology, AIG Hospitals and Asian Institute of Gastroenterology, Hyderabad, Telangana, India. A young woman who had surgical choledocho-duodenostomy 5 years ago for biliary adverse events soon after cholecystectomy presented with biliary obstruction. MRCP revealed a smooth mid-CBD stricture, intra-hepatic stone with …

Continue reading EUS-guided choledochoduodenostomy as a rescue after failed ERCP and percutaneous transhepatic biliary drainage in the management of postoperative benign biliary stricture

Early precut versus primary precut sphincterotomy to reduce post-ERCP pancreatitis

Post written by Sudhir Maharshi, MD, DM, and Shyam Sunder Sharma, DNB, DM, from the Department of Gastroenterology, SMS Medical College and Hospitals, Jaipur, India. The focus of our study was to assess the safety and efficacy of primary precut. It is well known that precut sphincterotomy, usually considered after repeated and failed cannulation, is …

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Use of a rigidizing overtube for altered-anatomy ERCP

Post written by Mike Tzuhen Wei, MD, from Stanford University, Stanford, and Veterans Affairs Palo Alto, Palo Alto, California. We present 2 cases in which the rigidizing overtube was used to facilitate performance of altered-anatomy ERCP. In the first case, a 53-year-old woman with history of Roux-en-Y hepaticojejunostomy presented for management of intrahepatic stones. Interventional …

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Gastric overtube use to prevent duodenoscope loop formation during EUS-directed transgastric ERCP procedure

Post written by Shelini Sooklal, MD, from the Division of Gastroenterology, Hepatology and Nutrition, Cleveland Clinic Foundation, Cleveland, Ohio, USA. This video case demonstrates the technique of using a disposable gastric overtube device to aid passage of the duodenoscope through a previously placed lumen apposing metal stent (LAMS), from the roux limb to the remnant …

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Digital single-operator peroral cholangioscopy-guided biopsy sampling versus ERCP-guided brushing for indeterminate biliary strictures

Post written by Mohan Ramchandani, MD, from the Asian Institute of Gastroenterology Hospitals, Hyderabad, India. The aim of this study was to assess the diagnostic accuracy of digital single-operator cholangioscopy (DSOC) compared with ERCP-based assessment using traditional sampling technology in patients with indeterminate biliary strictures (IBS). Indeterminate biliary stricture was defined as a suspected intrinsic …

Continue reading Digital single-operator peroral cholangioscopy-guided biopsy sampling versus ERCP-guided brushing for indeterminate biliary strictures

Type VI choledochal cyst diagnosed on ERCP with direct cholangioscopy

Post written by Lawrence Ku, MD, from the Division of Gastroenterology, Harbor-UCLA Medical Center, Torrance, California, USA. This case highlights the diagnostic dilemma of differentiating between 2 types of choledochal cysts, type II versus type VI. Although rare, these choledochal cysts have significant malignant potential, ranging from 5 to 7.5%. Malignant transformation of type VI …

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Electrohydraulic lithotripsy through a fistula of EUS-guided hepaticogastrostomy

Post written by Tatsuya Sato, MD, Yousuke Nakai, MD, PhD, from the Department of Gastroenterology, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. A 50-year-old man with a history of hepaticojejunostomy and Roux-en-Y reconstruction suffered from recurrent cholangitis due to bilateral intrahepatic stones. After failed double-balloon endoscope-assisted ERCP and percutaneous transhepatic biliary drainage, …

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Endotracheal anesthesia vs monitored anesthesia care and sedation-related adverse events during ERCP

Post written by Zachary L. Smith, DO, from the Division of Gastroenterology, Washington University School of Medicine, St Louis, Missouri, USA. The focus of this study was to evaluate the use of general endotracheal anesthesia (GEA) versus monitored anesthesia care (MAC) during ERCP in high-risk patients. Historically, our institution sedated the vast majority of patients …

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Rescue of a delayed spontaneously migrated lumen-apposing metal stent placed to facilitate transluminal ERCP

Post written by Prabhleen Chahal, MD, FACG, FASGE, and C. Roberto Simons-Linares, MD, MSc, from the Gastroenterology and Hepatology Department, Digestive Disease Institute, Cleveland Clinic Foundation, Cleveland, Ohio, USA. We present a case of a delayed spontaneously migrated lumen-apposing metal stent (LAMS) that was placed in a patient with a history of Roux-en-Y gastric bypass …

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Editor’s Choice: GEA vs MAC in high-risk patients undergoing ERCP

GIE Associate Editor, Dr. Sharmila Anandasabapathy, highlights this article from the April issue “A randomized controlled trial evaluating general endotracheal anesthesia versus monitored anesthesia care and the incidence of sedation-related adverse events during ERCP in high-risk patients” by Zachary L. Smith, DO, et al.  This is one of the few studies which compare, via a randomized …

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